This week’s case comes from our partner, Formlabs. Whilst every week you hopefully see the impact our 3D models can have on the prognosis of patients, this case study I think is a pretty extreme example. The surgical team had a fundamental life-changing decision to make – plan A or plan B. They did not have the information they needed to make that critical decision until they received the 1:1 scale 3D model from Axial3D and Formlabs.

Pre-operative planning is crucial to delivering successful surgery, thereby delivering optimum patient outcomes. The arrival of 3D printed anatomical models has revolutionized how surgeons obtain the critical insights that are needed before performing complex surgical procedures, leading to better outcomes for patients. With the help of Formlabs and Axial 3D, Mr. Alistair Irwin was able to successfully remove a tumor from a young patient.

For over five years, Mr Alistair Irwin has been a Consultant Orthopaedic Surgeon, practicing at the Royal Victoria Infirmary in Newcastle Upon Tyne, one of just four specialist spinal sarcoma centres in England. Mr Irwin undertakes all aspects of adult spinal surgery including minimally invasive techniques, with a specialist interest in spinal tumors, including spinal sarcomas shown in the case below.

The team at Newcastle completes approximately 10 spinal sarcomas resections per year. In what is a one in a million case, a young girl from Newcastle UK was faced with an extremely rare and aggressive form of cancer that was growing quickly from the thoracic spine and chest wall into the anterior thoracic cavity and mediastinum. After biopsy this was diagnosed as a Mesenchymal Chondrosarcoma, a cartilage producing tumor that was rapidly destroying local structures and causing damage. If left alone, it could cause catastrophic harm—compressing vital structures (such as major veins, arteries and even the structure of the heart), or start to compress the spinal cord and cause damage to the nerves and motor functions.

Spinal sarcomas are rare and require a highly specialized team including specialist oncologists, radiologists, pathologists and surgeons to care for them. In this particular case the site, size and complexity of the tumour required a surgical team comprising plastic, paediatric, cardiothoracic, paediatric cardiac and spinal surgeons. Because of its complexity, planning and visualization of the anatomical sites involved was crucial.

This particular type of tumor is usually only treatable with radical surgery. However, because of the young age of the patient and aggressive nature of the tumor, a trial of adjuvant chemotherapy was started under the care of the paediatric oncologist. Unfortunately, the tumor continued to grow.
This left two options for the team. Either declare the tumor inoperable because of its size and tricky location (sitting behind the heart, close to the lungs, bronchial tree, the aorta and the major Azygos vein in relation to the spine), or attempt to resect the tumor.

This type of tumor must be removed in one procedure, as they are likely to grow back if they are removed in pieces. So, the only safe way to remove the tumor was in one single resection with a safe margin of healthy tissue surrounding it to ensure the entire tumor was successfully removed.

The biggest difficulty for the team at this point was knowing exactly which structures were involved. Even with detailed MRI and CT imaging as well as transesophageal echo it was impossible for the team to ascertain whether the tumor was invading the heart or the atrium, or the involvement of the aorta and Azygos vein.

To better assess the anatomy, one of the cardiothoracic surgeons had put a camera inside the patient’s chest to get a better look. However, due to the size of the tumor he was unable to get an accurate view of the anatomy and structures such as the heart or aorta. Attempting to resect the tumor without a complete understanding of it and the surrounding anatomy was far too great a risk.

3D modeling software was unable to give the team the level of confidence and detail they needed, and the team was still unable to understand how the resection could take place.